咪达唑仑持续静脉维持治疗儿童癫持续状态副作用观察

目的观察咪达唑仑持续静脉维持治疗癫持续状态(SE)的副作用。方法应用咪达唑仑持续静脉维持治疗SE患儿38例,开始静脉注射0.1～0.2mg/kg,随后以0.1～0.4mg/(kg.h)持续静脉维持,根据发作状态调整剂量大小。结果26例SE患儿应用咪达唑仑维持治疗后癫发作停止。2例患儿因基础疾病死亡。副作用主要有呼吸道分泌物增多、下呼吸道感染、心率增快、意识障碍及尿潴留等。未见明显致死性副作用发生。结论应用咪达唑仑治疗SE安全有效。     

微量泵维持静脉注射咪达唑仑治疗惊厥持续状态疗效观察

目的研究咪达唑仑持续静脉泵入治疗小儿惊厥持续状态的临床效果及价值。方法选择惊厥持续状态患儿104例,随机分为两组:咪达唑仑组59例,地西泮组45例。咪达唑仑组静脉注射负荷量0.1～0.2 mg.kg-1后,以0.1～0.2 mg.kg-1.h-1持续泵入;地西泮组静脉注射负荷量0.2～0.3 mg.kg-1后,以0.1～0.2 mg.kg-1.h-1持续泵入。两组均根据惊厥发作次数调整至有效安全剂量,并维持至减量停药。观察两组患儿用药剂量、治疗有效性及不良反应。结果咪达唑仑组和地西泮组有效率分别是94.9%和80%,二组比较差异有统计学意义(χ2=4.65,P0.05);咪达唑仑对心率、血压无明显影响,而地西泮组心率、血压有明显降低(P0.05)。结论咪达唑仑比地西泮更能有效控制小儿惊厥持续状态,且对循环系统影响小。     

咪达唑仑治疗难治性惊厥持续状态29例

目的:研究咪达唑仑治疗难治性惊厥持续状态的疗效及临床价值。方法:对29例难治性惊厥持续状态患儿首先给予咪达唑仑负荷量0.2mg/(kg.次),30min后给予维持量1.0μg/(kg.min),每30min增加维持剂量1.0μg/(kg.min)直到惊厥停止。结果:29例患儿中26例在咪达唑仑维持量8.0μg/(kg.min)内惊厥停止,未发现明显不良反应。结论:咪达唑仑是治疗难治性惊厥持续状态的安全、有效的药物。     

咪达唑仑治疗儿童癫痫持续状态及惊厥频繁发作的临床研究

目的研究咪达唑仑持续静脉滴注治疗癫痫持续状态[SE,包括难治性癫痫(R SE)]及频繁惊厥发作(FCS)的临床疗效,同时探讨其安全有效剂量及副作用。方法选取收入院的SE及FCS患儿205例为观察对象,随机分为两组,治疗组103例,给予咪达唑仑持续静脉滴注;对照组102例,应用传统的一线抗癫痫药(AED s)治疗。同时将两组疗效进行对照研究,观察治疗组的最大、最小用药剂量,副反应,51例患儿进行脑电图监测。结果治疗组疗效明显高于对照组(P<0.01),治疗组的咪达唑仑安全有效剂量为1￣8μg.kg-1.m in-1,在治疗剂量下未见明显副作用,37例痫样放电随着临床发作的终止消失,14例随着发作次数的减少而减少。结论持续静脉滴注咪达唑仑治疗SE及FCS安全、可靠、有效,且常规一线AEDs治疗无效后该药仍有效,故该药可推荐为治疗癫痫持续状态及频繁惊厥发作的最佳选择。     

咪达唑仑在新生儿惊厥持续状态的应用研究

目的:观察新生儿惊厥持续状态应用咪达唑仑与苯巴比妥钠的疗效.方法:72例惊厥持续新生儿,随机分为治疗组及对照组各36例,治疗组予咪达唑仑负荷量0.1～0.3 mg/(kg·次)静脉推注,再予静脉维持量1.0μg(kg·min)维持,如果惊厥不能控制,则每15 min增加维持剂量1.0μg/(kg·min)直到惊厥停止.对照组予苯巴比妥钠10 mg/(kg·次),如果惊厥不能控制,30 min可以再予10 mg/(kg·次).注入药物1 h内惊厥停止为有效,1 h后惊厥未停止为无效,对比观察两组控制惊厥的时间.结果:治疗组有效率为83.0%,对照组有效率为67.0%;治疗组用药控制时间(22±15.2)min,对照组用药控制时间(31±16.3)min,治疗组疗效明显优于对照组,两组比较差异有统计学意义(P<0.05).结论:咪达唑仑是治疗新生儿惊厥持续状态快速、有效的药物.     

咪达唑仑治疗小儿惊厥持续状态15例

目的 探讨咪达唑仑治疗小儿惊厥持续状态的疗效。方法 将32例惊厥持续状态患儿随机分为两组,治疗组15例给予静脉注射负荷量咪达唑仑0.1～0.2 mg&#8226;kg-1镇静诱导,然后用微量注射泵持续泵入用0.9%氯化钠溶液配制成的0.1%咪达唑仑,根据患儿惊厥发作情况调整剂量,达到满意的镇静水平,发作停止后保持该泵入速度。对照组18例给予地西泮0.3～0.5 mg&#8226;kg-1静脉注射,如无效,15 min后重复一次。结果 治疗组显效8例,有效5例,无效2例;对照组显效6例,有效5例,无效6例,治疗组有效率明显高于对照组（P＜0.01）。结论 咪达唑仑治疗小儿惊厥持续状态有效。     

吗啡镇静治疗重症手足口病并神经源性肺水肿

目的:观察吗啡治疗重症手足口病并神经源性肺水肿(NPE)的镇静效果。方法:63例手足口病合并NPE患儿,行常规治疗与机械通气后随机分为两组,其中咪达唑仑组36例,吗啡组27例。咪达唑仑负荷量0.1 mg/kg,用生理盐水5～10 mL稀释后静脉推注,继以0.05～0.15 mg/(kg.h)输液泵静脉维持推注。吗啡负荷量0.05～0.1 mg/kg,用生理盐水5 mL稀释后静脉推注,继以吗啡10～40μg/(kg.h)输液泵静脉维持推注。比较两组用药期间血气分析、心率(HR)、呼吸(RR)、血压(BP)、血氧饱和度(SpO2)、氧合指数(OI)、平均气道压(MAP);观察两组患儿对镇静药物起效时间、达到满意镇静深度时间、上机时间。结果:吗啡组达到理想镇静水平的例数多于咪达唑仑组(P<0.05),吗啡组pH、HR、RR、SpO2、OI及MAP均较咪达唑仑组改善明显(P<0.05或P<0.01);吗啡组对药物起效时间、达到满意镇静深度时间、上机时间均少于咪达唑仑组(P<0.01)。结论:吗啡在手足口病并神经源性肺水肿治疗中的镇静效果好,在NPE患儿的镇静治疗中应优先考虑选择吗啡。     

咪达唑仑治疗新生儿惊厥持续状态的护理

新生儿惊厥持续发作可造成不可逆的脑损伤,所以其治疗须按急诊处理,先控制惊厥症状,再进行进一步对因治疗[1]。咪达唑仑(力月西)治疗新生儿惊厥持续状态具有明显的疗效。但对应用咪达唑仑引起的不良反应须加强护理。现将我院新生儿科2010年12月～2012年4月收治的27例新生儿持续惊厥应用咪达唑仑治疗的护理,总结如下。     

咪达唑仑治疗癫痫持续状态疗效的系统评价

目的系统评价咪达唑仑治疗癫痫持续状态(SE)的临床疗效。方法电子检索CENTRAL、Pubmed、Embase和中国生物文献数据库文献(CBM),全面收集咪达唑仑治疗SE的随机对照试验(RCT),采用Cochrane系统评价方法评价纳入RCTs的方法学质量后,提取试验组与对照组的治疗有效率、显效时间、不同给药方式给药时间、10 min内显效率、呼吸抑制发生率等数据,采用RevMan 5.1.4软件对提取的数据进行分析。计数资料使用Mantel-Haenszel法进行Meta分析,计量资料则使用倒方差法进行Meta分析,若各研究具有同质性选用固定效应模型,若各研究具有异质性则选用随机效应模型。结果共纳入7个RCTs,共854例。经口腔黏膜给咪达唑仑与经直肠给地西泮治疗SE有效率差异有显著意义(P=0.008,RR=1.25,95%CI:1.06¹.48);经非静脉途径给咪达唑仑与经静脉途径给地西泮治疗SE的有效率无显著差异(P=0.91,RR=1.00,95%CI:0.951.48);经非静脉途径给咪达唑仑与经静脉途径给地西泮治疗SE的有效率无显著差异(P=0.91,RR=1.00,95%CI:0.95¹.05)。经口腔黏膜给咪达唑仑比经直肠给地西泮治疗SE的显效时间短或相似;经非静脉途径给咪达唑仑与经静脉途径给地西泮治疗SE差异无显著意义(P=0.07,SMD=0.31,95%CI:-0.021.05)。经口腔黏膜给咪达唑仑比经直肠给地西泮治疗SE的显效时间短或相似;经非静脉途径给咪达唑仑与经静脉途径给地西泮治疗SE差异无显著意义(P=0.07,SMD=0.31,95%CI:-0.02⁰.63)。经非静脉途径给咪达唑仑给药时间比经静脉途径给地西泮给药时间短(P<0.000 1,SMD=-1.21,95%CI:-1.700.63)。经非静脉途径给咪达唑仑给药时间比经静脉途径给地西泮给药时间短(P<0.000 1,SMD=-1.21,95%CI:-1.70^-0.71)。结论经非静脉途径给咪达唑仑比经非静脉途径给地西泮治疗SE疗效更可靠,与经静脉途径给地西泮的疗效相当,但经非静脉途径给药时间更短,可早期控制SE。咪达唑仑安全性良好。     

咪达唑仑持续静脉泵入给药对小儿癫痫持续状态的缓解作用及其治疗对策

目的:评价咪达唑仑持续静脉泵入给药对小儿癫痫持续状态的缓解作用及其治疗对策。方法:选取2012年11月—2015年4月间收治的小儿癫痫持续状态患者90例,将其随机分为观察组和对照组(每组45例);两组患儿均给予咪达唑仑注射液持续静脉泵入给药治疗,对照组患者给予一般护理治疗,观察组患儿给予系统护理干预治疗,比较两组患儿治疗后的总有效率和不良反应的发生率。结果:观察组患儿治疗后的总有效率为95.56%高于对照组为75.56%(P<0.05),不良反应的发生率为6.67%低于对照组为22.22%(P<0.05)。结论:采用咪达唑仑持续静脉泵入给药并辅于系统护理干预治疗小儿癫痫持续状态,可以缓解癫痫症状的持续状态;此给药方法降低了不良反应的发生率。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.